Dr Haver, has amassed a following in the millions, all on the promise that women can thrive through menopause. Not everyone is celebrating her rise. Photos: Arturo Olmos/The New York Times
It was 10 in the morning, and Dr Mary Claire Haver, an OB-GYN, had already recorded a video in her pajamas on solutions for low sex drive for her combined four million followers on Instagram and TikTok. Now Haver, 56, was walking briskly on her Peloton treadmill while reading a study on female sexual dysfunction.
It was part of her normal morning routine, but this day, she was being filmed for a documentary series about thriving through perimenopause.
She squatted for the third time with an 38.5kg barbell. “I’m not thinking about what I’m going to look like in a bikini,” she said to the filmmakers who had gathered in her garage gym. “I’m thinking about what I’m going to look like at 80.”
With her shiny black hair, dark-rimmed glasses and lithe physique, Haver looked like the model of youth compared to the Golden Girls menopause stereotypes of yore.
Over the course of two days, in interviews at her home in Galveston, Texas in the United States, she repeated something she’d said to her audience that morning: If women are proactive, they aren’t destined to slowly decline after their reproductive years. Their menopausal years might even be their best years. Or, as she likes to say, “Menopause is inevitable; suffering through it is not.”
Six thousand women reach menopause every day in the US, but there are only about 2,300 providers certified in menopause medicine. Many women struggle to find clinicians who are experienced and informed enough to guide them through the transition.
The void has been filled by a thriving crowd of menopause influencers, with Haver at the helm. In the past two years, she has arguably done more to educate women about menopause than any other public figure, through her social media platforms and bestselling book The New Menopause.
Dr Haver films a video for social media at her home in Galveston, Texas.She has called out sexism in medicine, demanded increased federal funding for women’s health research and called on medical schools to better prepare doctors to care for women beyond their reproductive years.
Both publicly and in her private menopause practice, she has crusaded to dispel deep-seated fears about hormone therapy, arguing that it carries a long list of benefits.
On TikTok and Instagram, Haver comes across as authoritative and empathetic, addressing her followers as if they are not only her patients but also her friends. She speaks with urgency, often against a green-screen backdrop of a published study, breaking down research simply yet emphatically.
But in her efforts to help women navigate menopause today, she has also drawn criticism from menopause medicine’s longer-serving guard of doctors for recommending hormones for uses that stray from official medical guidelines and, they say, risk harming women. And she has built a multimillion-dollar wellness business, The ’Pause Life, selling supplements and diet plans in a way that some of her colleagues find ethically questionable. Several longtime menopause specialists and researchers said Haver embodied both the promise and perils of menopause care’s next chapter.
“I think she really is trying to advocate and do the right thing, largely,” said Dr Lisa Larkin, the immediate past president of the Menopause Society, the field’s top governing body in the US. But Larkin and others expressed concern that when health care providers sell anything – including their own expertise – on social media, important subtleties are lost or compromised. “It’s a very slippery slope in medicine.”
Haver hears the concerns, but says she is more interested in helping women.
Watch out for ‘whiny women’
Haver grew up in a large Catholic family in southern Louisiana, as one of the middle of eight children. Her parents owned a Cajun restaurant and were perplexed and concerned by her desire to forge a career in science and medicine. “Girls in my family did not do that,” she said – they got married, “had babies and, you know, they supported their husbands.”
But Haver had been deeply affected by losing an older brother to leukemia when she was nine, and becoming a doctor felt meaningful.
She completed medical school in Louisiana, where, like most physicians today, she received only about an hour of instruction on menopause.
During her residency in obstetrics and gynecology at the University of Texas Medical Branch hospital in Galveston, she got about six. (Today, only about 31% of OB-GYN residencies offer a menopause curriculum.)
As a first-year resident, she was told by a male supervisor in cowboy boots to watch out for WWs – “whiny women,” she said, in an exaggerated Southern accent – who were often in their late 40s and complained of vague, hard-to-pin-down symptoms like brain fog, poor sleep, weight gain, heart palpitations and a vanishing sex drive.
The implication, Haver said, was that these women didn’t actually have a serious medical condition; they were merely complainers.
The messaging stuck.
“To this day, when a patient comes in with multiple vague complaints, I have to walk myself back and say, ‘Listen to her. Believe her. This is real,’” Haver said.
Earlier this year, Haver rallied a constellation of about three dozen physician influencers into a group that calls itself the “menoposse” and enthusiastically supports one another’s work on Instagram and TikTok.
During Haver’s final year as a resident, in 2002, the limited menopause care that existed was diminished even further. That year, researchers overseeing the country’s first wide-scale study of health outcomes in postmenopausal women, known as the Women’s Health Initiative, abruptly ended their trial of estrogen and progestin therapy, after they saw a very small increase in breast cancer among some participants taking oral estrogen.
The findings are now considered to have been overblown, but headlines about the study had a chilling effect on treatment.
“We were giving HRT fairly often,” Haver said. “By the time I graduated like a month later, it was like, we shall not give it. You’re going to hurt someone.”
Nearly overnight, hormones fell out of fashion among menopausal women. By 2007, the number of eligible menopausal women taking them dropped below 5%. It had previously hovered around 40%.
Not long after, she and her husband, Chris Haver, a project manager at Chevron, decided to make Galveston their home and raise their two daughters there. She joined the hospital staff and built a busy OB-GYN practice.
It wasn’t until 2015, when Haver went through menopause herself at 48 and experienced crippling hot flashes and insomnia, that she began to question the prevailing belief that, beyond prescribing antidepressants and anti-anxiety drugs, there wasn’t much doctors could do to help women feel like themselves again.
“I can’t tell you how many times I was told, or I’ve told patients, ‘This is just what happens,’” she said. “You know, it’s tough to be a woman.”
Finally, in early 2016, when she felt she couldn’t live another day with her symptoms, Haver asked for oestrogen (and progestin, to protect against cancer of the uterine lining).
At first, she said, choosing to go on hormones felt like “throwing in the towel.”
But as her symptoms vanished, she felt happier and more energetic than she had in years – and outraged that women had been deprived of these benefits for so long.
The decision would mark the beginning of Haver’s more renegade approach to treating menopause, including bucking mainstream medical recommendations on hormones.
And in 2023, her approach was bolstered by a larger cultural shift in treatment. Health care providers say that hormones reentered the national conversation as a viable treatment for menopause symptoms after The New York Times Magazine published an article by Susan Dominus, titled “Women Have Been Misled About Menopause,” which explained why the earlier research on hormones and cancer risk had been misinterpreted.
Since then, some menopause experts have embarked on an aggressive public awareness campaign to educate women about the potential benefits of hormones and dispel blanket fears about their risks in an effort to get more women the help they need. Today, less than 4% of eligible menopausal women use hormones approved by the Food and Drug Administration, according to the Menopause Society, suggesting that many millions of women – and particularly those with low socioeconomic status and access to health care – are suffering needlessly.
Earlier this year, Haver rallied a constellation of about three dozen physician influencers into a group that calls itself the “menoposse” and enthusiastically supports one another’s work on Instagram and TikTok. Collectively, they have more than 5 million followers on Instagram alone. The menoposse now converses daily via a WhatsApp group. “We’re constantly sharing articles and asking opinions and talking about complicated cases,” Haver said. It’s part support group, part advisory board, part hype machine.
Haver and others in the menoposse argue that, while there aren’t yet large, long-term studies establishing the unarguable benefits of hormones for disease prevention, there eventually will be, and women shouldn’t have to wait decades for better care – which is how long it could take to gather enough evidence to change official guidelines.
‘Nuance doesn’t play on social media’
A theme runs through Haver’s posts: that women’s bodies need estrogen, progesterone and testosterone – all of which plunge during menopause – to function optimally, and that taking them not only can help with symptoms, but also help prevent cardiovascular disease and dementia and contribute to long-term health and happiness.
She also regularly reshares content from members of the menoposse that make these promises and more.
The problem is that studies haven’t definitively proven these claims – at least, the data isn’t considered strong enough for the Menopause Society (or any other medical society) to get on board with the kind of messaging the menoposse is putting forth.
Everyone the Times interviewed agreed that many more women could benefit from hormone therapy.
But longtime menopause specialists said they feared the cultural messaging about it had gone too far in the past few months, glossing over the health risks, including for breast cancer and certain cardiovascular diseases, and creating a misguided perception that hormones are essential for a woman’s general well-being as she ages.
The Menopause Society only recommends estrogen for women dealing with disruptive menopause symptoms, or those at a high risk for developing osteoporosis. It also recommends testosterone therapy to treat a low sex drive, though testosterone is not yet approved by the FDA for this use.
It does not recommend estrogen as a first-line tool for improving overall well-being, or for preventing heart disease or dementia for women who go through menopause at the average age. Clinical trial data on using estrogen for these purposes is limited, and the data that does exist is contradictory.
“Nobody in the Menopause Society is gatekeeping hormones. They’re saying, ‘This is what the research shows; this is what the good quality research shows,’” said Dr Jennifer Gunter, an OB-GYN and menopause specialist in San Francisco.
For these reasons, in its most recent guidelines, the Menopause Society urged health care providers to drop the term “hormone replacement therapy,” and swap it with “hormone therapy” or “menopausal hormone therapy,” to avoid creating the perception that estrogen, progesterone and testosterone need to be replaced as women age.
Unlike people with low levels of thyroid hormones or insulin, postmenopausal women with low levels of reproductive hormones can often live long, healthy lives, said Dr Stephanie Faubion, the society’s medical director and the director of the Mayo Clinic’s Center for Women’s Health.
Despite this, Haver’s message has landed – at least with many of the women who follow her on social media or have read The New Menopause.
“Women with no menopausal symptoms at all are asking for hormone therapy to reduce their lifetime risk of heart disease and dementia,” said Dr Nanette Santoro, a professor of obstetrics and gynecology at University of Colorado School of Medicine, who has been studying and treating menopausal patients since the early 1990s.
Haver and others in the menoposse argue that, while there aren’t yet large, long-term studies establishing the unarguable benefits of hormones for disease prevention, there eventually will be, and women shouldn’t have to wait decades for better care – which is how long it could take to gather enough evidence to change official guidelines.
She frequently suggests the menopause establishment is conservative in its recommendations, denying women crucial care that is based on promising, if not definitive, evidence.
“I sit in front of patients every day,” she said, and “they just want their lives back.”
They may not be experiencing the specific symptoms listed by the Menopause Society, she added, “but there’s been a dramatic shift in their resilience and how they’re managing the day-to-day activities of their lives, and they’re in a struggle.”
Every woman’s risks vary depending on her history and genetics. But for many patients – and for Haver herself – hormones indeed feel like a miracle cure.
But critics of Haver and the menoposse’s stridently pro-hormone therapy messaging argue this fine print gets lost in an online culture that doesn’t reward subtlety.
“In medicine, there’s a lot of nuance, and nuance doesn’t play on social media,” Gunter said.
Haver is a true believer in what she’s selling – literally and figuratively – on social media and through The ’Pause Life, where she oversees a staff of two full-time and around 18 part-time employees.
She follows her own dietary advice and takes the supplements she sells. She said she wanted to offer women the tools to thrive in the same way she has. But her business ventures also put her at odds with official medical guidelines, which discourage physicians from selling their own products to patients.
In early October, the nonprofit organisation Truth in Advertising issued a consumer alert about menopause supplement claims, and urged more than 100 brands to review their marketing. This list included The ’Pause Life, noting that its website “includes, among other things, claims that its supplements can help treat anxiety and muscle pain, help improve cognitive function and reduce fatigue.”
In response, Haver said she had hired a consultant to give The ’Pause Life website a close review and remove anything that doesn’t comply with the group’s recommendations. “We want to do this right,” she said.
A fight for the future of menopause care
At the Menopause Society’s annual meeting in Chicago last month, Faubion, the group’s medical director, said she heard numerous whispers from members about what they perceived as a social media-driven disinformation crisis that was promoting solutions lacking in evidence. “I’ve never heard this level of alarm and concern,” Faubion told the Times.
The society’s leaders also told the Times that the stakes had never been higher, since more clinicians were seeking its certification to practice menopause medicine than ever before, and they wanted to ensure they were practicing what they considered evidence-based care.
And so, in recent weeks, the Menopause Society has taken steps to try to discourage physician-influencers and their followers in the medical community from routinely making recommendations that don’t align with its guidelines: On Sept 30, the group released a statement to its members, which include Haver, urging clinicians to stick to the script.
A few hours later, Haver posted on Instagram about the danger of “weaponising guidelines” against women to deny them essential care. She later deleted the post. “I probably overreacted,” she told me.
Haver says she sometimes gets too fired up about what she perceives to be barriers to treatment. She has no plans to scale back her crusade to get menopausal women the care she believes they deserve. “Maybe my messaging isn’t perfect all the time,” she said. “But I take the negative, and I say, ‘How can I do better?’” And then, she added, “I keep going.” – The New York Times
